Health Care Cost

In a National Coverage Determination decision memo released Tuesday, CMS said it will gather public comment for 30 days about its plan to limit coverage for Alzheimer disease (AD) biologics that target plaque buildup in the brain to patients enrolled in certain clinical trials.

The Biden administration announced a requirement for insurance companies and group health plans to cover the cost of at-home COVID-19 tests; critical staffing shortages are reported nationwide amid record surges in COVID-19 cases and hospitalizations; the first-ever successful animal-to-human heart transplant was announced.

Posters from the Academy of Managed Care Pharmacy Nexus 2021 meeting detailed how coverage of genetic testing aligns with current guidelines as well as the potential budget impact of expanding access to comprehensive genomic profiling (CGP).

CMS proposed rulemaking Thursday that would pass pharmaceutical price concessions to beneficiaries in Medicare Part D plans and make the medical loss ratio in Medicare Advantage plans more robust.

An analysis concluded that cemiplimab may be more cost-effective than chemotherapy as first-line treatment for some US patients with non–small cell lung cancer (NSCLC).

Korean patients with moderate-to-severe atopic dermatitis achieved and maintained markedly improved skin clearance with dupilumab treatment in a real-world setting, including in the face and hands.

On this episode of Managed Care Cast, we bring you part 1 of an 8-part video conversation with Blue Cross Blue Shield of North Carolina and Newton Family Physicians about how they adapted to deliver health care in 2020 and 2021.

Analysis results revealed racial and sex disparities among patients with hypertrophic cardiomyopathy who receive implantable cardioverter-defibrillator (ICD) devices.

Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.

Anthony Fauci, MD, said the CDC is considering changes to its guidance requiring a negative COVID-19 test after 5-day quarantine; bipartisan legislation banning surprise medical billing goes into effect; booster vaccine programs may be limiting global vaccine supply for low- and middle-income countries.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 8.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 7.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 5.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 5.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 4.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 3.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 2.

This 8-part conversation with Blue Cross and Blue Shield of North Carolina and Newton Family Physicians, moderated by The American Journal of Managed Care® (AJMC®), focuses on the role of value-based care, independent care practices, and other aspects of health care that have been and continue to be affected by the continuing COVID-19 pandemic, even as we enter 2022. This is part 1.

The most-read AJAC papers of 2021 analyze real-world programs to transform health care and provide insight into physician perspectives of health care and insurance.

This year’s most-read articles on Medicare covered topics including accountable care organizations, value-based payment, and star ratings.

A new study comparing intensive care unit stays among patients with Parkinson disease and controls without the disease found the former have more severe illness, but both groups have similar survival rates.

The editors of The American Journal of Managed Care® and The American Journal of Accountable Care® reflect on the past year and discuss the themes and topics they expect to see in 2022.

Anne Barmettler, MD, an associate professor of ophthalmology, visual sciences, and plastic surgery at Montefiore Medical Center, discusses the cost of teprotumumab for thyroid eye disease.

Interest in the use of digital inhalers is growing, as they may provide real-world evidence about how patients monitor and treat their chronic obstructive pulmonary disease (COPD) and asthma at home, but additional questions need to be answered, according to a recent review.

The CDC is recommending that people at risk of developing blood clots receive the Moderna or Pfizer/BioNTech vaccines instead of Johnson & Johnson (J&J); the FDA lifts restrictions on mail order access to abortion pills; US health care spending more than doubled during the first year of the pandemic.

Three policies to revamp insurance consumer protections for health care delivery are explored, with highlighted areas for improvement being maternal health coverage and loosening of network adequacy requirements.

More Americans reported skipping medical care over cost concerns; today marks the 1-year anniversary of the COVID-19 vaccine rollout; hospitals in Minnesota are overwhelmed with COVID-19 patients.

Theresa Juday, RPh, director, Specialty Product Development, CVS Health, discusses the indirect and direct cost burden associated with chronic insomnia.

Key quality and savings metrics as measured within the most recent performance period from The Centers for Medicare & Medicaid Innovation (CMMI) for the Oncology Care Model (OCM) demonstrated Florida Cancer Specialists & Research Institute as a top performing oncology practice nationwide.

Pfizer predicts that a fourth dose of a COVID-19 vaccine may be needed to quell the Omicron variant; CMS officials share figures on enrollment for health coverage under the Affordable Care Act (ACA); City of Hope announces acquisition of Cancer Treatment Centers of America.